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Member
Benefits
Coordinator
Department:
Operations
and
Compliance
Location:
Rehoboth
Beach,
Delaware
Summary:
Responsible
for
administration
of a
member
compliance
program;
telephone
outreach
to
perform
member
education;
answering
general
telephone
and
email
inquiries
from
employers,
insurance
brokers,
vendors,
health
care
providers,
members
and the
general
public;
and,
assisting
with
daily
activities
of
operating
a small
office
location.
Administration
of the
member
compliance
programs
involves
daily
collection
and
manual
entry of
data
from
multiple
databases
and
incoming
correspondence;
applying
a rule
based
decision
process;
generation
of
emails,
letters
and
reports;
initiating,
receiving
and
confirming
electronic
file
transfers;
and,
processing
members’
appeals
of
decisions.
Answering
telephone
and
email
inquiries
will
involve
directly
answering
questions
about
the
compliance
program
and
general
business
inquires
and for
other
inquires,
understanding
the
nature
of the
inquiry
and
directing
the
caller
to the
correct
resource
to
obtain
an
answer.
Essential
Duties
and
Responsibilities
include
the
following.
Other
duties
may be
assigned
to meet
business
needs.
-
Execute
time
sensitive
daily,
weekly
and
monthly
business
processes
related
to
the
member
compliance
program
accurately
and
within
set
deadlines.
-
Produce
periodic
activity
reports
related
to
member
compliance
and
appeals.
-
Help
to
improve
business
processes
in
order
to
reduce
time
to
process,
improve
accuracy
and
to
help
members
avoid
having
benefits
reduced.
-
Make
outreach
phone
calls
in
order
to
provide
member
education.
-
Maintain
the
confidentiality
of
sensitive
and
legally
protected
personal
and
medical
information
of
members’
and
use
and
disclose
it
only
to
the
minimum
extent
required
to
perform
job
functions.
-
Accurately
answer
telephone
inquires
from
members
or
their
representatives
regarding
the
basis
for
benefit
level
determinations.
-
Answer
incoming
phone
calls
and
provide
a
response
or
direct
the
caller
to
an
appropriate
resource
by
transferring
the
call
or
providing
additional
contact
information.
-
Provide
back-up
to
the
Marketing
Coordinators
during
absence.
-
Open
office
on
time
in
the
morning
and
close
office
at
the
end
of
each
day.
Open,
sort
and
distribute
incoming
mail
each
day.
-
Prepare
and
send
outgoing
mail
related
to
the
member
compliance
function
and
for
response
to
general
business
inquiries.
-
Order
and
maintain
a
supply
of
necessary
office
supplies
and
postage.
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